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 Synergy for
Clinical
Excellence
The AACN Synergy Model for Patient Care

SECOND EDITION

Edited by
Sonya R. Hardin, PhD, NP-C, RN, CCRN
Professor
College of Nursing
East Carolina University
Greenville, North Carolina

Roberta Kaplow, PhD, AOCNS, APRN, CCRN

Clinical Nurse Specialist
Emory University Hospital
Atlanta, Georgia
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Library of Congress Cataloging-in-Publication Data
Names: Hardin, Sonya R., editor. | Kaplow, Roberta, editor.
Title: Synergy for clinical excellence : the AACN synergy model for patient care / editors, Sonya R. Hardin, Roberta
Kaplow.
Description: Second edition. | Burlington, MA: Jones & Bartlett Learning,
[2017] | Includes bibliographical references and index.
Identifiers: LCCN 2016013601 | ISBN 9781284106565 (pbk.)
Subjects: | MESH: Critical Care Nursing—standards | Models, Nursing |
Treatment Outcome | Nurse Practitioners | Certification
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Printed in the United States of America
20 19 18 17 16 10 9 8 7 6 5 4 3 2 1
 Dedication

This book is dedicated to Susan, Grace, Jessie, James, Bria, and Adam. We are
indeed grateful for your love, support, and encouragement during our time away
from home working on the production of this book.

iii
 Contents

Preface................................................................................................................ xiii
Acknowledgments............................................................................................... xv
Contributors....................................................................................................... xvi

Section I Introduction..........................................................1
Chapter 1 Introduction.................................................................................3
Mary Frances D. Pate
Introduction.................................................................................. 3
Synergy and Me .......................................................................... 3
Development of the Synergy Model............................................ 4
Synergy Model Assumptions ...................................................... 6
Patient Needs and Characteristics ............................................... 6
Nurse Competencies and Characteristics..................................... 6
Certified Nursing Practice............................................................ 7
Synergy Beyond Acute and Critical Care ................................... 7
Conclusion.................................................................................... 9
References.................................................................................. 10

Section II Patient Characteristics.......................................11

Chapter 2 Resiliency...................................................................................13
Roberta Kaplow
Introduction................................................................................ 13
Resiliency and Patient Outcomes............................................... 14
Definition.................................................................................... 14
Factors Promoting Resiliency.................................................... 15
Role of the Healthcare Provider................................................. 15
Application of the Case Study to the Synergy Model................ 16
Examples of Resiliency Levels.................................................. 16
Conclusion.................................................................................. 17
References.................................................................................. 17
Chapter 3 Vulnerability..............................................................................19
Roberta Kaplow
Introduction................................................................................ 19
Types of Vulnerability................................................................ 19

iv
 Contents v

Sources of Vulnerability............................................................. 19
Definition.................................................................................... 21
Nursing Strategies...................................................................... 22
Application of the Case Study to the Synergy Model................ 23
Examples of Resource Availability Levels................................. 23
Conclusion.................................................................................. 23
References.................................................................................. 23
Chapter 4 Stability......................................................................................25
Roberta Kaplow
Introduction................................................................................ 25
Predicting Instability.................................................................. 26
Definition.................................................................................... 27
Application of the Case Study to the Synergy Model................ 28
Examples of Stability Levels in Practice.................................... 28
Conclusion.................................................................................. 29
References.................................................................................. 29
Chapter 5 Complexity.................................................................................31
Roberta Kaplow
Introduction................................................................................ 31
Sources of Complexity............................................................... 31
Definition.................................................................................... 33
Application of the Case Study to the Synergy Model................ 34
Examples of High Complexity Levels in Practice..................... 34
Conclusion.................................................................................. 34
References.................................................................................. 34
Chapter 6 Resource Availability ................................................................36
Roberta Kaplow
Introduction................................................................................ 36
Human Resources ...................................................................... 36
Type of Insurance....................................................................... 37
Definition.................................................................................... 38
Application of the Case Study to the Synergy Model................ 39
Examples of Resource Availability Levels................................. 39
Conclusion.................................................................................. 39
References.................................................................................. 39
Chapter 7 Participation in Care ................................................................42
Roberta Kaplow
Introduction................................................................................ 42
Levels of Participation in Care................................................... 43
Factors Impacting Participation in Care..................................... 44
Roles in Participation in Care.................................................... 45
Obstacles to Participation in Care.............................................. 45
Outcomes of Patient Participation in Care................................. 46
vi Contents

Definition.................................................................................... 46
Patient Strategies to Promote Participation in Care................... 46
Provider Strategies to Promote Participation in Care................. 47
Application of the Case Study to the Synergy Model................ 49
Examples of Participation in Care.............................................. 49
Conclusion.................................................................................. 49
References.................................................................................. 50
Chapter 8 Participation in Decision Making............................................52
Roberta Kaplow
Introduction................................................................................ 52
Definition.................................................................................... 53
Barriers to Participation in Decision Making............................. 53
Nursing Strategies...................................................................... 54
Application of the Case Study to the Synergy Model ............... 55
Examples of Participation in Decision-Making Levels.............. 55
Conclusion.................................................................................. 56
References.................................................................................. 56
Chapter 9 Predictability ............................................................................58
Roberta Kaplow
Introduction................................................................................ 58
Survival of Critical Illness.......................................................... 59
Incidence and Timing of Side Effects........................................ 59
Intensive Care Unit Scoring Systems......................................... 59
Definition.................................................................................... 60
Application of the Case Study to the Synergy Model................ 61
Examples of Predictability Levels.............................................. 61
Conclusion.................................................................................. 61
References.................................................................................. 62

Section III Nurse Characteristics........................................ 65

Chapter 10 Clinical Judgment.....................................................................67
Kristin Curcio
Introduction................................................................................ 67
Clinical Judgment....................................................................... 67
Expert Clinical Judgment .......................................................... 68
Development of Clinical Judgment............................................ 69
Definition.................................................................................... 69
Application of the Case Study to the Synergy Model ............... 71
Conclusion.................................................................................. 72
References ................................................................................. 72
Chapter 11 Advocacy/Moral Agency...........................................................74
Carolyn Horne
Introduction................................................................................ 74
Definition.................................................................................... 74
 Contents vii

Moral Agency............................................................................. 75
Advocacy and the Synergy Model............................................. 76
Application of the Case Study to the Synergy Model................ 78
Conclusion.................................................................................. 78
References ................................................................................. 78
Chapter 12 Caring Practices........................................................................80
Donna Roberson and Sonya R. Hardin
Introduction................................................................................ 80
Caring Practices......................................................................... 80
Caring Skills............................................................................... 81
Caring in Nursing....................................................................... 81
Competency for Evaluating Caring Practices............................ 82
Definition.................................................................................... 82
Translation into Practice............................................................. 83
Application of the Case Study to the Synergy Model................ 85
Conclusion.................................................................................. 85
References.................................................................................. 85
Chapter 13 Collaboration.............................................................................88
Donna Lake and Roberta Kaplow
Introduction................................................................................ 88
Definition.................................................................................... 89
Collaboration in the Intensive Care Unit.................................... 89
Elements of Effective Collaboration.......................................... 90
Barriers to Effective Collaboration............................................ 90
Opportunities for Multidisciplinary Collaboration
in the ICU................................................................................... 90
Quality Care Delivery................................................................ 91
Interprofessional Collaboration.................................................. 92
How Did We Get Here? Importance of Collaboration
in Nursing................................................................................... 93
Communication.......................................................................... 95
The Master’s Essentials.............................................................. 96
Effective Teams.......................................................................... 97
Team Tools................................................................................. 97
Conclusion.................................................................................. 97
Application of the Case Study to the Synergy Model................ 99
References.................................................................................. 99
Chapter 14 Systems Thinking....................................................................102
Sonya R. Hardin
Introduction.............................................................................. 102
Causal Loops............................................................................ 103
Archetypes................................................................................ 104
Systems Modeling.................................................................... 104
Definition.................................................................................. 105
viii Contents

Translation into Practice........................................................... 105

Application of Case Study #1 to the Synergy Model............... 107
Application of Case Study #2 to the Synergy Model............... 109
Conclusion................................................................................ 109
References................................................................................ 109
Chapter 15 Response to Diversity..............................................................111
Tomika M. Williams
Introduction.............................................................................. 111
Response to Diversity Skills.................................................... 111
Competency for Evaluating Response to Diversity.................. 112
Definition.................................................................................. 113
Application of the Case Study to the Synergy Model.............. 114
Translation into Practice........................................................... 115
Conclusion................................................................................ 115
References................................................................................ 115
Chapter 16 Clinical Inquiry.......................................................................118
Robin Webb Corbett
Introduction.............................................................................. 118
Competency for Evaluating Clinical Inquiry........................... 119
Definition.................................................................................. 120
Application of the Case Study to the Synergy Model.............. 121
Conclusion................................................................................ 122
References................................................................................ 122
Chapter 17 Facilitation of Learning..........................................................124
Jane Miles
Introduction.............................................................................. 124
Theories of Learning................................................................ 124
Facilitator of Learning in Nursing............................................ 125
Competency for Facilitator of Learning................................... 125
Definition.................................................................................. 126
Translation into Practice........................................................... 126
Application of the Case Study to the Synergy Model.............. 129
Conclusion................................................................................ 129
References................................................................................ 129

Section IV Application of the Synergy Model.................. 131

Chapter 18 Application of the Synergy Model to Clinical Practice .......133
Marianne Baird
Introduction.............................................................................. 133
The Synergy Model as a Framework for Nursing
Rounds...................................................................................... 134
The Interdisciplinary Team...................................................... 134
Nursing Competencies............................................................. 137
 Contents ix

Hospital Readmission............................................................... 139

Nursing Competencies at End of Life...................................... 139
Spirituality and the Synergy Model......................................... 140
Patients’ Characteristics Related to Spirituality....................... 140
Resource Availability............................................................... 140
Nurses’ Characteristics Related to Spirituality........................ 141
Response to Diversity............................................................... 141
Caring Practices: Accurately Identify Spiritual Needs............. 142
Response to Diversity: Make Congruent Matches................... 142
Support Resiliency: Make Appropriate Referrals.................... 142
Support Resiliency: Make Space and Time for Group and
Individual Religious Rituals and Spiritual Practices................ 143
Synergy Model: Preceptorship................................................. 143
Assumptions of the Synergy Model for Patient Care............... 143
Corollary Assumptions for the Synergy
Model for Preceptorship........................................................... 144
Conclusion................................................................................ 145
References................................................................................ 146
Chapter 19 Application of the Synergy Model to Nursing Research ......147
Randy M. Gordon
Introduction.............................................................................. 147
Conceptual and Theoretical Frameworks................................. 147
Importance of Frameworks and Research................................ 148
Synergy Model as a Framework............................................... 148
Synergy Model as a Research Instrument................................ 152
Conclusion................................................................................ 153
References................................................................................ 153
Chapter 20 Professional Practice Models: The Implementation
Equation...................................................................................155
Marsha Hughes-Rease
Introduction.............................................................................. 155
Case in Point: A Real-Life Exemplar....................................... 156
What Is a Professional Practice Model?................................... 158
The Implementation Equation: E 3 A 3 E . R..................... 159
Conclusion................................................................................ 163
References................................................................................ 163
Chapter 21  pplication of the Synergy Model to Conducting
A
Scholarly Projects for the Doctor of Nursing Practice........166
Christine Estabrook
Introduction.............................................................................. 166
The DNP Scholarly Project...................................................... 166
The American Association of Critical-Care Nurses
Synergy Model for Patient Care............................................... 167
x Contents

Developing the DNP QI Project............................................... 169

Phenomenon of Interest/Nursing Theory................................. 170
Application of Synergy Model to the DNP QI Project............ 170
Conclusion................................................................................ 172
References................................................................................ 172
Chapter 22 Application of the Synergy Model to Orientation................175
Julie Miller
Introduction.............................................................................. 175
Tool Development: Concepts................................................... 175
Tool Development: The Process............................................... 176
Navigating the Change............................................................. 182
Piloting the Tool....................................................................... 182
Evaluation................................................................................. 191
Conclusion................................................................................ 192
References................................................................................ 192
Chapter 23 Application of the Synergy Model to Nursing Leadership..... 194
Lynn Whelan
Introduction.............................................................................. 194
Competency.............................................................................. 195
Job Descriptions....................................................................... 195
Peer Review.............................................................................. 196
Nursing Productivity................................................................ 196
Staffing Ratios.......................................................................... 196
Acuity Tools............................................................................. 197
Clinical Ladder Development.................................................. 197
Healthy Work Environments.................................................... 197
Orientation of Nurse Leaders................................................... 198
Conclusion................................................................................ 199
References................................................................................ 199
Chapter 24  pplication of the Synergy Model in Perioperative
A
Services.....................................................................................201
D. Jane Vosloh
Introduction.............................................................................. 201
Perioperative Services.............................................................. 201
Application of the Case Study to the Synergy Model.............. 204
Conclusion................................................................................ 205
References................................................................................ 205
Chapter 25 Application of the Synergy Model to Ambulatory Care......206
Curlissa Mapp, Deena Gilland, and Melanie Watson
Introduction.............................................................................. 206
Ambulatory Care Nursing........................................................ 206
Telehealth................................................................................. 207
Care Coordinator...................................................................... 207
 Contents xi

Application of the Case Study to the Synergy Model.............. 209

Conclusion................................................................................ 209
References................................................................................ 210

Chapter 26 Implications of the Synergy Model for Academia................211

Amy Rex Smith
Introduction.............................................................................. 211
Unique Features of the Academy............................................. 211
Taking on the Academic Role in Nursing................................ 212
Conceptual Models in Nursing in Academic Institutions........ 212
Synergy Model Options in Academic
Settings—Curriculum Issues.................................................... 213
Tenure and Promotion Concerns for
Those Following the AACN Synergy Model........................... 214
How to Thrive, Not Just Survive.............................................. 215
Conclusion................................................................................ 215
References................................................................................ 215

Chapter 27 Application of the Synergy Model for Development

of a Patient Acuity System......................................................216
Mary A. Stahl and Tracy L. Rogers
Introduction.............................................................................. 216
Nurse Scores............................................................................. 217
Patient Scores........................................................................... 218
Making Shift Assignments....................................................... 219
Evaluation of Pilot.................................................................... 220
Next Steps................................................................................ 222
Conclusion................................................................................ 222
References................................................................................ 223

Chapter 28 Consensus Model for APRN Regulation: Licensure,

Accreditation, Certification, and Education...........................224
Carol Hartigan
Introduction.............................................................................. 224
Goals of the Consensus Process............................................... 224
APRNs—How to Regulate?..................................................... 225
Certification vs. Licensure Examinations................................ 225
Self-Regulation: Hallmark of a Profession.............................. 226
Parallel Processes..................................................................... 227
Is There Any Synergy in the Model?........................................ 228
Development of Additional Resources..................................... 228
Synergy Model within CNS Core Competencies..................... 229
Learning from the Consensus Process..................................... 230
Conclusion................................................................................ 232
References................................................................................ 233
xii Contents

Section V Practice Exam Questions................................ 235

Chapter 29 Acute/Critical Care Nursing (Adult) (CCRN) Questions......237
Vicki Morelock
References................................................................................ 248
Answer Key.............................................................................. 248
Chapter 30  cute/Critical Care Nursing (Pediatric) (CCRN)
A
Questions..................................................................................249
Jodi Mullen
References................................................................................ 258
Answer Key.............................................................................. 258
Chapter 31  cute/Critical Care Nursing (Neonatal) (CCRN)
A
Questions..................................................................................259
Kim Cooley and Rachel Joseph
Reference.................................................................................. 268
Answer Key.............................................................................. 268
Chapter 32  cute Care Nurse Practitioner
A
(Adult-Gerontology) (ACNPC-AG) Questions.....................269
Jeffrey Boon
References................................................................................ 281
Answer Key.............................................................................. 281
Chapter 33  linical Nurse Specialist; Wellness through Acute
C
Care (Adult-Gerontology) (ACCNS-AG) Questions............282
Lisa Reif
References................................................................................ 293
Answer Key.............................................................................. 294
Chapter 34 Progressive Care Nursing (PCCN) (Adult) Questions.........295
Becky Dean
References................................................................................ 304
Answer Key.............................................................................. 304
Chapter 35  ertified Nurse Manager and Leader (CNML)
C
Questions..................................................................................305
Mary Bylone
References................................................................................ 313
Answer Key.............................................................................. 313

Index ............................................................................ 315

 Preface

This book is a tribute to all the acute and critical care nurses who serve patients
worldwide. It is based upon decades of work by the American Association of
­Critical-Care Nurses (AACN) in the development of a conceptual framework
for nursing practice: The AACN Synergy Model. The purpose of this book is to
provide nurses with the clinical knowledge needed to apply the Synergy Model
in practice and to help prepare nurses for certification examinations offered by
AACN. Significant additions were made to this edition of the book. As the mod-
el’s use has grown exponentially in a number of arenas, chapters have been added
to demonstrate how the model is applicable in the non-intensive care setting. For
example, chapters on integration of the Synergy Model in the perioperative and
ambulatory settings have been added. This edition also has chapters that illustrate
application of the Model to the practice setting, nursing administration, research,
nursing orientation programs, and as a basis for a Doctor of Nursing Practice
project, creating a patient acuity system, and for obtaining Magnet® designation
by the American Nurses Credentialing Center. A chapter was written to tie the
­Synergy Model to the APRN Consensus Model. This text can be utilized in a
nursing course that focuses on nursing theory and conceptual frameworks. The
chapters with practice questions have also been expanded in this edition of the
book. There are seven chapters with practice questions for certification examina-
tions to help prepare exam candidates.
Chapter 1 presents a brief history of the development of the model and
the patient and nurse characteristics inherent in the Synergy Model. The first
chapter in Section I serves as a foundation for understanding the application
of the concepts in each of the chapters that follow. Section II provides in-depth
chapters focusing on each patient characteristic in the model with application
to patient situations to further explicate the use of the model in practice. Sec-
tion III consists of chapters focused on the nurse characteristics with applica-
tions to practice. Section IV consists of chapters that illustrate how the Synergy
Model has been utilized in a variety of clinical and non-clinical settings. Sec-
tion V has sample test questions for those nurses seeking to obtain certification
through AACN or the American Association of Nurse Executives. These ques-
tions provide the nurse with further examples of the integration of the model
into practice.

xiii
xiv Preface

We would like to thank the contributors to the second edition of this book.
This book has been edited to enhance the readers’ understanding of the Synergy
Model. It should also provide a reference to those who are in the process of utiliz-
ing the model in their practice and those considering having a theoretical basis for
their practice.
Sonya R. Hardin
Roberta Kaplow
 Acknowledgments

We gratefully acknowledge the outstanding contributors of this text. Without the

expertise of these scholars, this work would not have been possible.
We express sincere appreciation to AACN and AACN Certification Corpora-
tion for permission to use the Synergy Model graphic representation and for their
commitment to optimize patient care through certified practice. We would like to
recognize Carol Hartigan for her continued insightfulness in integrating the Syn-
ergy Model into certified practice.
We also thank the following people with Jones & Bartlett Learning: Teresa Reilly
and Juna Abrams, as well as Escaline Charlette Aarthi with S4Carlisle who handled
the day-to-day copyediting, typesetting, and proofreading stages of the book.
Lastly, a special thanks must be extended to our families and friends who have
supported us during the production of the book. Their support and encouragement
has helped to sustain us during the final production.
Sonya R. Hardin
Roberta Kaplow

xv
 Contributors
Marianne Baird, MN, RN, ACNS-BC Christine Estabrook, DNP, MSN,
Corporate Director, Magnet Recognition ANP-BC, AOCNP
Program Assistant Professor
Emory Healthcare University of South Alabama
Atlanta, GA Mobile, AL

Jeffrey Boon, MSN, RN, AGACNP-BC Deena Gilland, MSN, RN, OCN,
Neurology/Neurosurgery ICU Nurse NEA-BC
Practitioner VP and CNO Ambulatory
Assistant in Anesthesiology, Division of Patient Care
Anesthesiology Critical Care Medicine Emory Healthcare
Vanderbilt University Medical Center Adjunct Instructor Nell Hodgson
Nashville, TN Woodruff School of Nursing
Atlanta, GA
Mary Bylone, MSM, RN, CNML
President, Leaders Within, LLC Randy M. Gordon, DNP, FNP-BC
Colchester, CT Assistant Professor
Chamberlain College of Nursing
Kim Cooley, MSN, APRN, NNP-BC, Chicago, IL
CCNS
Neonatal Clinical Nurse Specialist Sonya R. Hardin, PhD, NP-C, RN,
Emory University Hospital Midtown CCRN
Atlanta, GA Professor
East Carolina University College
Robin Webb Corbett, PhD, FNP-C, of Nursing
RNC Greenville, NC
Department Chair, Department of
Advanced Practice and Education Carol Hartigan, MA, RN
East Carolina University College of Certification and Policy
Nursing Strategist
Greenville, NC American Association of Critical-Care
Nurses
Kristin Curcio, DNP, AGPCNP-BC, AACN Certification Corporation
AOCNP Aliso Viejo, CA
Clinical Assistant Professor
Community Practice Nursing Carolyn Horne, PhD, RN, BC
University of North Carolina, Greensboro Director, Clinical Nurse Specialist
Greensboro, NC Concentration
Assistant Professor
Becky Dean, MSN, APRN, ACNS-BC, Graduate Department
CCRN East Carolina University College
Clinical Nurse Specialist of Nursing
Emory University Hospital Greenville, NC
Atlanta, GA

xvi
 Contributors xvii

Marsha Hughes-Rease, MSOD, MSN, RN Jodi Mullen, MS, RN-BC, CCRN,

Organization Effectiveness Consultant CCNS, ACCNS-P
and Leadership Coach Clinical Leader, Pediatric Intensive
ANA Consultant to support organizations Care Unit
on the Magnet journey University of Florida Health
Herndon, VA Shands Children’s Hospital
Gainesville, FL
Rachel A. Joseph, PhD, RN, CCRN
Assistant Professor Mary Frances Pate, PhD, RN
West Chester University of Pennsylvania Assistant Professor
West Chester, PA East Carolina University College of
Clinical Nurse, Neonatal ICU Nursing
Christiana Hospital Greenville, NC
Newark, DE
Lisa Reif, MSN, RN, APRN-CCNS,
Roberta Kaplow, PhD, AOCNS, APRN, CCRN
CCRN Clinical Nurse Specialist, Neuroscience ICU
Clinical Nurse Specialist Emory University Hospital
Emory University Hospital Atlanta, GA
Atlanta, GA
Donna Roberson, PhD, RN, FNP-BC
Donna Lake, PhD, RN, NEA-BC Associate Professor
Clinical Associate Instructor Assistant Director of Program Evaluation
Graduate Department East Carolina University College of
East Carolina University College of Nursing
Nursing Greenville, NC
Greenville, NC
Tracy L. Rogers, MSN, RN, PCCN
Curlissa P. Mapp, MSN, APRN, Clinical Nurse Manager
ACNS-BC Saint Luke’s East Hospital
Magnet Program Coordinator & Lee’s Summit, MO
Ambulatory Clinical Nurse Specialist
Amy Rex Smith, PhD, RN, ACNS, BC
Emory Clinic, Inc.
Professor of Nursing and Director, RN to
Atlanta, GA
BSN Program
Belhaven University, School of Nursing
Jane Miles, PhD, MSN, RN,
Jackson, MS
NEA-BC
Assistant Professor Mary A. Stahl, MSN, RN, ACNS-BC,
East Carolina University College of CCNS, Alumnus CCRN
Nursing Clinical Practice Specialist
Greenville, NC American Association of Critical-Care
Nurses
Julie Miller, BSN, RN, CCRN Aliso Viejo, CA
Critical Care Consultant
American Association of Critical-Care D. Jane Vosloh, RN, CNOR
Nurses Assistant Administrator, Perioperative
Aliso Viejo, CA Services, Retired
Emory Healthcare
Vicki Morelock, MN, APRN-CNS, Atlanta, GA
ACCNS-AG, CCRN
Clinical Nurse Specialist Melanie Watson, RN, OCN
Emory University Hospital Myeloma Team Nurse
Midtown Bone Marrow Transplant
Atlanta, GA Winship Cancer Institute of Emory
Healthcare
Atlanta, GA
xviii Contributors

Lynn Whelan, DNP, RN, NEA-BC, ONC Tomika Williams, PhD(c),

Associate Chief Nursing Officer Cardiac & AGPCNP-C, RN-BC
Radiology Procedural Areas & Enterprise Clinical Assistant Professor
Staffing Pool East Carolina University College
Emory Hospitals of Nursing
Atlanta, GA Greenville, NC
S e c t i o n I

Introduction
Another random document with
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The Project Gutenberg eBook of Hannibal's
daughter
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Title: Hannibal's daughter

Author: Andrew Haggard

Release date: November 20, 2023 [eBook #72182]

Language: English

Original publication: London: Hutchinson & Co, 1898

Credits: an anonymous Project Gutenberg volunteer

*** START OF THE PROJECT GUTENBERG EBOOK HANNIBAL'S

DAUGHTER ***
Hannibal’s Daughter
BY
LIEUT. COL. ANDREW HAGGARD, D.S.O.
Author of
“Tempest Torn,” “Under Crescent and Star,” etc., etc.

LONDON
HUTCHINSON & CO.
PATERNOSTER ROW
1898
 Dedication.
TO HER ROYAL HIGHNESS THE PRINCESS LOUISE,
MARCHIONESS OF LORNE.

Madam,
Surely never, in the history of the world, have events more
romantic been known than the career of Hannibal and of his eventual
conqueror, the youthful Scipio. Therefore, under the title of
“Hannibal’s Daughter,” it has been my humble effort to present to the
world in romantic guise such a story as may impress itself upon the
minds of many who would never seek it for themselves in the classic
tomes of history.
Having been commenced on the actual site of Ancient Carthage,
the local colouring of the opening chapters may be, with the aid of
history, relied upon as being correct. Throughout the whole work,
moreover, the thread of the story has been interwoven with a
network of those wonderful feats that are so graphically recorded for
us in the pages of Polybius and Livy.
To Your Royal Highness, with the greatest respect, I have the
honour to dedicate my work. Should there appear to be aught of art
in the manner in which I have attempted to weave a combination of
history and romance, may I venture to hope that a true artist like
Your Royal Highness, of whose works the nation is justly proud, may
not deem the results of my efforts unworthy.

I have the honour to be,

Madam,
Your most obedient servant,
ANDREW C. P. HAGGARD.

Alford Bridge, Aberdeenshire, May, 1898.

 CONTENTS
PART I.
I. HAMILCAR
II. CARTHAGE
III. HANNIBAL’S VOW
PART II.
I. ELISSA
II. MAHARBAL
III. FOREWARNED
IV. FOUR CARTHAGINIAN NOBLES
V. PLOTS AND COUNTER-PLOTS
VI. CLEANDRA’S CUNNING
VII. MELANIA’S MISERY
VIII. LOVE FULFILLED
IX. A LAUGH AND A LIFE
PART III.
I. SOSILUS AND CHŒRAS
II. A GIGANTIC SCHEME
III. HANNIBAL’S DREAM
IV. FIRST BLOOD
V. AT THE FOOT OF THE ALPS
VI. OVER THE ALPS
VII. HANNIBAL’S FIRST TRIUMPH
VIII. EUGENIA
IX. THRASYMENE
X. FRIENDS MUST PART
XI. ELISSA AS A WARRIOR
XII. SOPHONISBA AND SCIPIO
XIII. ON THE BRINK
XIV. CANNÆ
PART IV.
 I. AFTER THE BATTLE
II. WIFE OR MISTRESS
III. FIGHTING WITH FATE
IV. THE FRUITS OF FOLLY
V. MARS VICTORIOUS
VI. CŒCILIA’S DEGRADATION
VII. A RENUNCIATION
PART V.
I. TO SYRACUSE
II. FROM SYRACUSE TO MACEDON
III. A SACRIFICE
IV. A LETTER FROM SCIPIO
V. A SCENE OF HORROR
PART VI.
I. A SPELL OF PEACE
II. ELISSA WRITES TO SCIPIO
III. A TERRIBLE SEA FIGHT
IV. ELISSA’S MISERY
V. HIS LEGAL WIFE
VI. A MOMENTOUS MEETING
VII. ZAMA
VIII. CONCLUSION
HANNIBAL’S DAUGHTER.
 PART I.

CHAPTER I.
HAMILCAR.

On a point of land on the Tœnia, a hundred paces or so to the south

of the canal connecting the sea with the Cothon or double harbour of
Carthage, stood a palatial residence. Upon the balcony, which ran
completely round the house on the first storey, stood a man gazing
steadily across the gulf towards the north-east, past the end of the
Hermæan Promontory, to the left, of which the distant Island of
Zembra alone relieved the monotony of the horizon. His face was
grave, and his short hair and beard were slightly grey, but he was
evidently a man from whom the fire of youth had not yet departed.
His eye was the eye of one born to command; his straight-cut, sun-
burned features told the tale of many campaigns. Near him, on a
stool covered with a leopard skin, was carelessly thrown a steel
helmet richly incrusted with gold, and with the crest and the crown
deeply indented, as if from recent hard usage. The golden crest was
in one place completely divided by a sword cut, the brighter colour of
the gold within the division plainly showing that the blow had been
but lately delivered. On the floor of the balcony, at the foot of the
stool, lay a long straight sword. Although the hilt was of ivory, and
the scabbard of silver inlaid with gems, the blood-stains on the
former and the absence of many of the gems from their sockets, told
that this was no fair-weather weapon for state occasions, but a lethal
blade which had been borne by its owner in the brunt of many a
combat. Only, the armour which the warrior wore—consisting as it
did merely of a bright steel breast-piece, upon the breast of which
was emblazoned in gold a gorgeous representation of the sun, the
emblem of the great god Baal or Moloch, and the back of which was
similarly inlaid with the two-horned moon, the attribute of the glorious
Astarte, Queen of Heaven, and further studded with golden stars, the
emblems of all the other and lesser divinities—seemed on first
appearance as if more intended for the court than the camp. A closer
examination, however, revealed the fact that this also was no mere
holiday armour, for it, too, bore severe marks of ill-usage. The
warrior’s arms were bare from the elbow downwards, save for a
couple of circlets of gold upon each wrist, which from their width
seemed more intended for defence than ornament. Beneath the
armour he wore a bright toga of pure white cloth, the lower part
falling in a kilted skirt below the knee, being adorned with a narrow
band of Tyrian purple. Upon his feet he wore cothurns or sandals
strongly attached with leather thongs, the thongs being protected
with bright chain mail. Some steel pieces for the protection of the
thigh and knee were lying close at hand.
Such was the attire of the great General Hamilcar Barca, as with
an ever-deepening frown upon his anxious brow, he gazed sternly
and steadily in deepest reverie across the sea.
At length his reverie seemed to be broken.
“Why gaze thus towards Sicily,” he muttered; “why dream of
vengeance upon the hated Romans, who now occupy from end to
end of that fair isle, where, for many years, by the grace of
Melcareth, the invisible and omnipotent god, I was able with my
small army of mercenaries to deal them so many terrible and
crushing blows?
“Have they not almost as much cause to hate and to dread me,
who did so much to lower their pride and wipe out the memory of
their former victories? Did I not brave them for years from Mount
Ercte, descending daily like a wolf from the mountain crest, to ravage
the country in front of their very faces in strongly-fortified Panormus,
from the shelter of whose walls, for very fear of my name, they
scarcely dared to stir, so sure were they that their armies would be
cut to pieces by Hamilcar Barca?
“Did I not firmly establish myself in Mount Eryx, half-way up its
slope in the city on the hill, and there for two years, despite a huge
Roman army at the bottom, and their Gallic allies holding the fortified
temple at the top, snap my fingers at them, ay, laugh them to scorn
and destroy them by the thousand? For all that time, was not their
gold utterly unable to buy the treachery of my followers—were not
their arms utterly futile against my person? Did they not indeed find
to their cost that I was indeed the Hamilcar my name betokens—him
whom the mighty Melcareth protects?”
Proudly glancing across the sea with a scornful laugh, he
continued:
“Oh, ye Romans! well know ye that had not mine own countrymen
left me for four long years without men, money, or provisions, Sicily
had even now been mine. Oh, Prætor Valerius! what was thy much
boasted victory of the Œgatian Islands over the Admiral Hanno but
the conquest of a mere convoy of ill-armed cargo vessels, whom
mine economical countrymen were too parsimonious to send to my
relief under proper escort. Where was then thy glory, Valerius? And
thou, too, Lutatius Catulus? how did I receive thy arrogant proposals
that my troops should march out of Eryx under the yoke? I, a
Hamilcar Barca, march out under the yoke!” The General’s swarthy
cheek reddened at the thought. “Did not I but laugh in thy beard and
lay my hand upon this sword—which I now lift up and kiss before
heaven,” he raised and kissed the blood-stained hilt. “Did not I, even
as I do now, but simply bare the well-known blade,” here he drew it
from its sheath, “and thou didst fall and tremble before me, and in
thine anxiety to rid Sicily of me didst willingly take back thine insult
and offer to Hamilcar and all his troops the full and free liberty to
march out with all the honours of war? Ah!” he continued, stretching
forth his sword menacingly across the sea, “for all that it hath been
mine own countrymen who were the main cause of my downfall, I yet
owe thee a vengeance, Rome, a vengeance not for mine own but for
my country’s sake, and, with the help of the gods, in days not long to
come, those of my blood shall redden the plains and mountains of
Europe with the terrible vengeance of the Barcine sword.”
The General returned his sword to its sheath with an angry clang,
then striding across the wide balcony to where it overlooked a
beautiful garden on the other side of the house, he shouted loudly:
“Hannibal, Hannibal!”
 There was no reply, but down beneath the shelter of the fig trees
Hamilcar could plainly perceive three little boys engaged in a very
rough game of mimic warfare. They were all three armed with
wooden swords and small shields of metal. One of them was up in a
fig tree and striking downwards at the head of one who stood upon
the crown of a wall; while the third boy, who stood below the wall,
was striking upwards at his legs. The din of the resounding blows
falling upon the shields was so great that the boy at first did not hear.
“Hannibal, come hither at once,” cried out his father again in
louder tones.
Looking up and seeing his father, the boy on the wall threw down
his shield, a movement which was instantly taken advantage of by
each of the two other boys to get a blow well home. He did not,
however, pause to retaliate, but crying out, “That will I revenge later,”
threw down his sword also and rushed into the house and up to the
balcony, for even at his early age the boy had been taught discipline
and instant obedience, and he knew better than to delay. He
appeared before his father all out of breath and with torn clothing.
Notwithstanding that his forehead was bleeding from the result of the
last cut which had been delivered by the boy in the tree, he did not
attempt to wipe the wound, but with cast-down eyes and hands
crossed over his breast, silently awaited his father’s commands.
“What wast thou doing in the garden, Hannibal?”
“Waiting until Chronos the slave could take me up to see the burnt
sacrifice to Baal of the mercenaries whom thou hast conquered,” he
answered—then added excitedly, “Matho, who murdered Gisco and
his six hundred after mutilating them first, is to be tortured, thou
knowest, oh, my father, Chronos told me so, and I am going to see it
done.”
Hamilcar frowned.
“Nay, it is not my will that thou shalt go to see Matho tortured and
burnt; now, what else wast thou doing down there?”
The boy’s face fell; he did not like to be deprived of the pleasure of
seeing Matho tortured first and burned afterwards, for, boy as he
was, he knew that if ever man in this world deserved the torture, that
man was this last surviving chief of his father’s revolted mercenaries.
 But he made no protest at the deprivation of his expected
morning’s amusement, answering his father simply.
“I was playing with my brothers Hasdrubal and Mago at thine
occupation of the City on Mount Eryx, oh! my father. Mago was up in
the tree and represented the Gauls who had deserted and joined the
Romans. Hasdrubal was down below and took the place of the
Roman Army.”
“And thou wast in thy father’s place between the two, and like thy
father himself, hast been wounded,” replied Hamilcar, smiling grimly.
“Come, wipe thy face, lad, and tell me why didst not thou, being the
strongest, take the part of the Romans at the bottom of the hill?”
Fiercely the youth raised his head, and, looking his father straight
in the face, replied:
“For two reasons, my father. First, I am much stronger than
Hasdrubal, and the war would have been too soon over; secondly, I
hate the Romans, and for nothing in the world would I represent
them even in play.”
“Ah! thou hatest the Romans! And wilt thou then fight them one
day in earnest and avenge the torrents of Carthaginian blood they
have caused to flow, the hundreds of Carthaginian cities whose
inhabitants they have put to the sword; avenge, too, our defeat and
loss of forty-one elephants before Heraclea; the sacking of
Agrigentum and enslavement of 25,000 of its citizens; the terrible
loss of three hundred warships at Ecnomos; the invasion of
Carthaginia by Regulus; his sacking and burning of all the fair
domain between here and Clypea, across yonder Hermæan
Promontory; the capture by Cœcilius Metellus before Panormus of
120 elephants from Hasdrubal, all of them slaughtered in cold blood
as a spectacle for the Roman citizens in the Roman circus; the fight
at—”
“Stop, father, stop!” cried the young Hannibal, stamping his foot. “I
can bear no more. By thy sword here, which I can even now draw—
see I do so—I swear to fight and avenge all these disasters. By the
favour of the great god Baal, whose name I bear, I will wage war
against them all my life as soon as ever I am old enough to carry
arms.”
 “Good,” said his father, “thou art a worthy son of Hamilcar, and this
very day shalt thou swear, not in the bloody temple of Moloch, but in
the sacred fane of Melcareth, the god of the city, the god of thy
forefathers in Tyre, and the god of the divine Dido, the foundress of
Carthage, that never wilt thou relax the hatred to the Romans thou
hast even now sworn by thy father’s sword. Never shalt thou, whilst
life lasts thee, cease to fight for thy native city, thy native country.
Look forth, my lad, upon all thou canst see now, and say, is it not a
fair domain? Let all that lies before thine eyes now sink down deep
into the innermost recesses of thy memory, for soon I shall take thee
hence; but I would not have thee, when far away, forget the sacred
city for whose very existence thou and I must fight. When thou hast
gazed thy fill upon all that lies before us, thou must perform thine
ablutions, arrange thy disordered dress, and then thou shalt
accompany me, not to see the sacrifice of the mercenaries in the pit
of fire before the brazen image of Moloch, but to make thy vow in the
temple of the invisible and all-pervading mighty essence of godhead,
the eternal Melcareth.”
 CHAPTER II.
CARTHAGE.

The terrible war, known as the inexpiable or the truceless war, was
just at an end, after three years’ duration. The mercenaries who had
served so faithfully under Hamilcar in Sicily had by the bad faith of
the Carthaginian Government, headed by Hamilcar’s greatest
enemy, Hanno, been driven to a revolt to try and recover the arrears
of pay due to them for noble services for years past. When the effete
Hanno, after a first slight success, had allowed his camp to be
captured, the Government, at the last gasp, had begged Hamilcar to
fight against his own old soldiers. For the sheer love of his country,
he had, although much against the grain, consented to do so. But
the towns of Utica, the oldest Phœnician town in Africa, and of Hippo
Zarytus were joining in the revolt; the Libyans and Numidians had
risen en masse to join the revolutionists, and the Libyan women,
having sold all their jewellery, of which they possessed large
quantities, for the sake of the revolted mercenaries, there was soon
so much money in the rebel camp that the very existence of
Carthage itself was at stake. Therefore, although Hamilcar well knew
that all the mercenaries, whether Libyans or Ligurians, Balearic
Islanders, Greeks, or Spaniards, were personally well disposed to
himself, he had been forced to take up arms against them.
Under Spendius, a Campanian slave, and Matho, an African in
whom they had formerly placed great trust, the rebels had gained
various successes, and, on visiting them in their camp, had
treacherously made prisoner of Gisco, a general in whom they had
previously expressed the greatest trust, and whom they had asked to
have sent to them with money to arrange their difficulties. Hamilcar
had been at first much hampered by his enemy, Hanno, an
effeminate wretch, being associated in the command with himself;
but when the Carthaginians found that, by leaving Hanno to hamper
Hamilcar, with all these well-trained soldiers against them, they had
got the knife held very close to their own luxurious throats, they
removed Hanno, and left the patriotic Hamilcar in supreme military
command. Their jealousies of him would not have allowed the
aristocracy and plutocracy to have done so much for the man whom
they had deserted for so long in Sicily had they not known their own
very existence to be at stake. For they ran the risk of being killed
both by the Libyans and mercenaries outside, and by the
discontented people inside the walls.
When Hamilcar assumed supreme command, the war had very
soon commenced to go the other way. He forced the easy, luxurious
Carthaginian nobles to become soldiers, and treated them as
roughly as if they had been slaves. And he made them fight. He got
elephants together; he made wonderful marches, dividing the
various rebel camps; he penned them up within their own fortified
lines. Many deserted and joined him; many prisoners whom he took
he released; a great African chief named Naravas came over to his
side. All was going well for Carthage when Spendius and Matho
mutilated and murdered the wretched General Gisco and his six
hundred followers in cold blood. After that no more of their followers
dared to leave them for fear of the terrible retaliation that they knew
awaited them. But how Spendius and all his camp were at length
penned up and reduced to cannibalism, eating all their prisoners and
slaves, how Spendius and his ten senators were taken and crucified,
while Matho, at the same time issuing from Tunis, took and crucified
a Carthaginian general and fifty of his men, and how at length, after
slaughtering or capturing the 30,000 or 40,000 remaining rebels,
Hamilcar took Matho himself prisoner, are all matters of history.
On the morning of the opening of our story, there was to be a
terrible sacrifice offered up to the great Baal Hammon, the sun god
Moloch, the Saturn of the Romans: the terrible monster to whom in
their hours of distress the Carthaginians were in the habit of offering
up at times their own babies, their first-born sons, or the fairest of
their virgins, whose cruel nuptials consisted not in being lighted with
the torch of Hymen, but in being placed bound upon the
outstretched, brazen, red-hot hands of the huge image, from whose
arms, which sloped downwards, they rolled down into the flaming
furnace at his feet. And fathers and mothers, sisters and brothers,
yea, even the very lovers of the girls, looked on complacently,
thinking that in thus sacrificing their dearest and their best to the
cruel god, they were consulting the best interests of their country in a
time of danger. Nor were the screams of the victims, many of whom
were self-offered, allowed to be heard, for the drums beat, the
priests chanted, and the beautiful young priestesses attached to the
temple danced in circles around, joining the sound of their voices
and their musical instruments to the crackling of the fire and the
rolling of the drums.
When Hamilcar bid his boy, Hannibal, look forth upon the city
before him, on the sea in front and behind him, and upon the country
around, it was a lovely morning in early summer. The weather was
not yet hot; there was a beautiful north-west breeze blowing down
the Carthaginian Gulf straight into the boy’s face, tossing up little
white horses on the surface of the sea, of which the white-flecked
foam shone like silver on its brilliantly green surface. Across the gulf,
upon whose bosom floated many a stately trireme and quinquireme,
to the east side arose a bold range of rugged mountains with steep,
serrated edges. Turning round yet further and facing the south, the
young Hannibal could see the same mountain range, dominated by a
steep, two-horned peak, sweeping round, but gradually bearing back
and so away from the shores of the shallow salt water lake then
known as the Stagnum, now called the Lake of Tunis. This lake was
separated, by the narrow strip of land called the Tœnia, from the
Sirius Carthaginensis, or Gulf of Carthage, upon the extremity of
which is now built the town of Goletta. There was in those days, as
now, a canal dividing this isthmus in two, and thus giving access for
ships to Tunis, a distance of ten miles from Carthage, at the far end
of the Tunisian lake.
Turning back again and looking to the north and north-west,
Hannibal saw stretching before him the whole noble City of
Carthage, of which his father’s palace formed one of the most
southern buildings within the sea wall. Close at hand were various
other palaces, with gardens well irrigated and producing every kind
of delicious fruit and beautiful flower to delight the palate or the eye.
Here waved in the breeze the feathery date palm, the oleander with
its wealth of pink blossom, the dark-green and shining pomegranate
tree with its glorious crimson flowers. Further, the fig, the peach tree,
the orange, the lemon, and the narrow-leaved pepper tree gave
umbrageous shelter to the winding garden walks. Over the
cunningly-devised summer-houses hung great clusters of blue
convolvulus or the purple bourgainvillia, while along the borders of
plots of vines gleaming with brilliant verdure, clustered, waist-high,
crimson geraniums and roses in the richest profusion. Between
these palaces lay stretched out the double harbour for the merchant
ships and war ships, a canal forming the entrance to the one, and
both being connected with each other. The harbour for the merchant
ships was oblong in shape, and was within a stone’s throw of the
balcony upon which the boy was standing. The inner harbour was
perfectly circular, and surrounded by a fortification; and around its
circumference were one hundred and twenty sets of docks, the gates
of each of which were adorned with beautiful Ionic pillars of purest
marble.
In the centre of this cup, or cothon as it was called, there was an
island, upon which was reared a stately marble residence for the
admiral in charge of the dockyards, and numerous workshops for the
shipwrights. All were designed and built with a view to beauty as well
as utility.
For that day only, the clang of hammers had ceased to be heard,
and all was still in the dockyards, for there was high holiday and
festival throughout the whole length and breadth of the City of
Carthage on the glad occasion of the intended execution, by fire, of
Matho and the remaining rebels who had not fallen by the sword in
the last fight at Tunis.
Just beyond the war harbour, there was a large open place called
the Agora, and a little beyond and to the left of it Hannibal could
descry the Forum placed on a slight elevation. It was a noble
building, surrounded by a stately colonnade of pillars, the capitals of
which were ornamented in the strictly Carthaginian style, which
seemed to combine the acanthus plant decoration of the Corinthian
capital, with the ram’s horn curves of the Ionic style. Between the
pillars there stood the most beautiful works of art, statues of Parian
marble ravished in the Sicilian wars, or gilded figures of cunning
workmanship of Apollo, Neptune, or the Goddess Artemis, being the
spoils of Macedon or imported from Tyre. The roof of the Forum was
constructed of beautiful cedar beams from Lebanon, sent as a
present by the rulers of Tyre to their daughter city, and no pains or
expense had been spared to make the noble building, if not equal in
grandeur, at any rate only second in its glorious manufacture to the
magnificent temple of Solomon, itself constructed for the great king
by Tyrian and Sidonian workmen.
A couple of miles away to the left could be seen the enormous
triple fortification stretching across the level isthmus which
connected Carthage, its heights and promontories, with the
mainland. This wall enclosed the Megara or suburbs, rich with the
country houses of the wealthy merchant princes. It was forty-five feet
high, and its vaulted foundations afforded stabling for a vast number
of elephants. It reached from sea to sea, and completely protected
Carthage on the land side. Between the city proper and this wall
beyond the Megara, everywhere could be seen groves of olive trees
in richest profusion, while between them and the frequent intervening
palaces, were to be observed either waving fields of ripening golden
corn, or carefully cultivated vegetable gardens, well supplied with
running streams of water from the great aqueduct which brought the
water to the city from the mountains of Zaghouan sixty miles away.
To the north of the Forum and beyond the Great Place, the city
stretched upwards, the width of the city proper, between the sea and
the suburbs, being only about a mile or a mile and a half. It sloped
upwards to the summit of the hill of the Byrsa or Citadel, hence the
boy Hannibal, from his position on the sea level in rear of the
harbours, was able to take in, not only the whole magnificent coup
d’œil of palaces and temples, but also that of the high and
precipitous hill forming Cape Carthage, which lay beyond it to the
north, whose curved and precipitous cliffs enclosed on the eastern
side a glittering bay, wherein were anchored many vessels of
merchandise.
The summit of this mountain was, like the suburbs of the Megara
to the west of the city, studded with the rich country dwellings of the
luxurious and ease-loving inhabitants of Carthage.
But it was not on the distant suburbs that the lad fixed his eager
gaze, it was on the gleaming city of palaces itself. Here, close at
hand on the right, he could see the temple of Apollo with its great